Provider Demographics
NPI:1669483194
Name:BUSCH, DANIEL AVERY (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:AVERY
Last Name:BUSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 N. MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-373-7300
Mailing Address - Fax:312-573-1249
Practice Address - Street 1:737 N. MICHIGAN AVENUE
Practice Address - Street 2:SUITE 1200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-373-7300
Practice Address - Fax:312-573-1249
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 0558212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055821Medicaid
IL01615704OtherBCBS ILLINOIS
26001124OtherRAILROAD MEDICARE
IL605450Medicare ID - Type Unspecified
014259Medicare UPIN
IL644591Medicare ID - Type Unspecified